Effect of early use of noradrenaline on in-hospital mortality in haemorrhagic shock after major trauma: a propensity-score analysis

Gauss, Tobias; Gayat, Étienne; Harrois, Anatole; Raux, Mathieu; Follin, Arnaud; Daban, J.-L.; Cook, Fabrice; Hamada, Sophie; Attias, Arié; Ausset, Sylvain; Boutonnet, Mathieu; Dhonneur, Gilles; Duranteau, Jacques; Langeron, Olivier; Mantz, Jean; Paugam–Burtz, Catherine; Pirracchio, Romain; Riou, Bruno; Maurice, Guillaume de St; Vigué, Bernard; Bertho, Kilian; Chollet-Xémard, C.; Dolveck, F.; Michelland, Laurianne; Reuter, Paul‐Georges; Ricard-Hibon, A.; Richard, Olivier; Sapir, D.; Vivien, Benoît

doi:10.1016/j.bja.2018.02.032

Cited by 24 publications

(23 citation statements)

References 37 publications

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“…In this registry, severe bleeding is defined as the need for an early transfusion of at least 4 units of PRBC within the first 6 hours after hospital admission. 35,36 Patients who died of hemorrhagic causes before receiving 4 units of PRBCs were also included. The patients who died on the scene or during hospital transfer without any blood transfusion were not included.…”

Section: Methodsmentioning

confidence: 99%

Association of Early, High Plasma-to–Red Blood Cell Transfusion Ratio With Mortality in Adults With Severe Bleeding After Trauma

et al. 2019

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Key PointsQuestionIs an early, high transfusion ratio of fresh frozen plasma to packed red blood cells associated with 30-day mortality in patients with severe bleeding after trauma?FindingsIn this cohort study of 897 patients in the French national trauma registry Traumabase, an early, high transfusion ratio of fresh frozen plasma to packed red blood cells was associated with increased 30-day mortality in patients with severe bleeding after trauma.MeaningThese results support an early, high transfusion ratio of fresh frozen plasma to packed red blood cells as part of the hemostatic resuscitation strategy in severe trauma.

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Section: Methodsmentioning

confidence: 99%

Association of Early, High Plasma-to–Red Blood Cell Transfusion Ratio With Mortality in Adults With Severe Bleeding After Trauma

et al. 2019

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“…However, previous retrospective studies have highlighted an association between the use of vasopressors and mortality in trauma patients [37–39]. By correcting for confounding factors, our group recently reported in a large multicenter study that early use of vasopressors was not associated with mortality in trauma patients presenting with hemorrhagic shock [15]. Similar to this study, our predictive model takes into account the most relevant factors of illness severity, which may explain the lack of association between vasopressors and AKI.…”

Section: Discussionmentioning

confidence: 99%

“…In the database, hemorrhagic shock is defined by the transfusion of at least four units of packed red blood cells (RBC) within the first 6 h [14, 15]. Traumatic brain injury (TBI) is defined by at least one traumatic lesion on the initial cerebral CT scan.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and risk factors for acute kidney injury among trauma patients: a multicenter cohort study

Harrois¹,

Soyer²,

Gauss³

et al. 2018

Crit Care

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BackgroundOrgan failure, including acute kidney injury (AKI), is the third leading cause of death after bleeding and brain injury in trauma patients. We sought to assess the prevalence, the risk factors and the impact of AKI on outcome after trauma.MethodsWe performed a retrospective analysis of prospectively collected data from a multicenter trauma registry. AKI was defined according to the risk, injury, failure, loss of kidney function and end-stage kidney disease (RIFLE) classification from serum creatinine only. Prehospital and early hospital risk factors for AKI were identified using logistic regression analysis. The predictive models were internally validated using bootstrapping resampling technique.ResultsWe included 3111 patients in the analysis. The incidence of AKI was 13% including 7% stage R, 3.7% stage I and 2.3% stage F. AKI incidence rose to 42.5% in patients presenting with hemorrhagic shock; 96% of AKI occurred within the 5 first days after trauma. In multivariate analysis, prehospital variables including minimum prehospital mean arterial pressure, maximum prehospital heart rate, secondary transfer to the trauma center and data early collected after hospital admission including injury severity score, renal trauma, blood lactate and hemorrhagic shock were independent risk factors in the models predicting AKI. The model had good discrimination with area under the receiver operating characteristic curve of 0.85 (0.82–0.88) to predict AKI stage I or F and 0.80 (0.77–0.83) to predict AKI of all stages. Rhabdomyolysis severity, assessed by the creatine kinase peak, was an additional independent risk factor for AKI when it was forced into the model (OR 1.041 (1.015–1.069) per step of 1000 U/mL, p < 0.001). AKI was independently associated with a twofold increase in ICU mortality.ConclusionsAKI has an early onset and is independently associated with mortality in trauma patients. Its prevalence varies by a factor 3 according to the severity of injuries and hemorrhage. Prehospital and early hospital risk factors can provide good performance for early prediction of AKI after trauma. Hence, studies aiming to prevent AKI should target patients at high risk of AKI and investigate therapies early in the course of trauma care.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2265-9) contains supplementary material, which is available to authorized users.

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“…All patients had a contrast-enhanced whole-body computed tomography (CT) to assess injury severity in the initial phase of care. In the database, hemorrhagic shock was defined by transfusion requirements of at least four units of packed red blood cells (RBC) within the first 6 h [18,19].…”

Section: Data Collectionmentioning

confidence: 99%

Admission serum myoglobin and the development of acute kidney injury after major trauma

Tarazona

Figueiredo

Hamada

et al. 2021

Ann. Intensive Care

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Background Myoglobin and creatine kinase (CK) are both established markers of muscle injury but their hospital admission values have never been compared to predict post-traumatic acute kidney injury (AKI). Methods An observational registry study of consecutive trauma patients admitted to a major regional trauma centre. The primary outcome was stage 1 or more AKI in the first 7 days after trauma. We assessed the association of hospital admission myoglobin or CK with development of AKI both alone and when added to two existing risk prediction models for post traumatic AKI. Results Of the 857 trauma patients (median age 36 [25–52], 96% blunt trauma, median ISS of 20 [12–47]) included, 102 (12%) developed AKI. Admission myoglobin performed better than CK to predict AKI any stage with an AUC–ROC of 0.74 (95% CI 0.68–0.79) and 0.63 (95% CI 0.57–0.69), respectively (p < 0.001). Admission myoglobin also performed better than CK to predict AKI stage 2 or 3 [AUC–ROC of 0.79 (95% CI 0.74–0.84) and 0.74 (95% CI 0.69–0.79), respectively (p < 0.001)] with a best cutoff value of 1217 µg/L (sensitivity 74%, specificity 77%). Admission myoglobin added predictive value to two established models of AKI prediction and showed significant ability to reclassify subjects regarding AKI status, while admission CK did not. Decision curve analysis also revealed that myoglobin added net benefit to established predictive models. Admission myoglobin was better than CK at predicting development of significant rhabdomyolysis. Conclusions Admission myoglobin better predicts the development of AKI and severe rhabdomyolysis after major trauma. Admission myoglobin should be added in established predictive models of post-traumatic AKI to early identify high-risk patients.

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Effect of early use of noradrenaline on in-hospital mortality in haemorrhagic shock after major trauma: a propensity-score analysis

Abstract: The results of the present study suggest that noradrenaline use in the early phase of traumatic HS does not seem to affect mortality adversely. This observation supports a rationale for equipoise in favour of a prospective trial of the use of vasopressors in HS after trauma.

Cited by 24 publications

References 37 publications

Association of Early, High Plasma-to–Red Blood Cell Transfusion Ratio With Mortality in Adults With Severe Bleeding After Trauma

Association of Early, High Plasma-to–Red Blood Cell Transfusion Ratio With Mortality in Adults With Severe Bleeding After Trauma

Prevalence and risk factors for acute kidney injury among trauma patients: a multicenter cohort study

Admission serum myoglobin and the development of acute kidney injury after major trauma

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